Functional and aesthetic outcomes after index pollicization using two different techniques in children with thumb hypoplasia – A comparative study

Abstract

Background

As several skin incision patterns have been described when performing index pollicization, it is currently difficult to know whether one incision is superior to another.

Hypothesis

Functional and aesthetic outcomes of two techniques of pollicization that differ in the incision pattern (Buck-Gramcko and Malek’s technique) were analyzed.

Patients and methods

Of 81 patients operated on between 1987 and 2021, 43 self-questionnaires were completed on 48 pollicized hands and 24 were reviewed for the study. Eighteen and 30 pollicizations were performed according to Buck Gramcko’s and Malek’s techniques, respectively.

Results

Following a functional analysis evaluation, no significant differences were observed between the two groups in terms of the appearance of the first commissure, active abduction of the neo-thumb, grip assessment, scar appearance and visibility, and neo-thumb girth. However, passive abduction of the thumb was better in the group operated on using Buck-Gramcko's technique at the last follow-up. Regardless of the technique used, patients were generally satisfied with the overall function, aesthetics, and daily use of the neo-thumb, as demonstrated by self-completed questionnaires.

Conclusion

This investigation demonstrated the superiority of Buck-Gramcko's technique in terms of passive abduction of the thumb. There was no impact on the function or aesthetics of the neo-thumb, and the results were comparable across the different techniques. The main prognostic factor requiring additional procedures involving opposition muscle transfer is the association with a radial club hand.

Level of evidence

Level III—Retrospective comparative study.